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Biomedical subjects

Lynn A Volk

Publications and source records attributed to Lynn A Volk.

10 recordsLinked to original sources
PubMed2006

Correlates of electronic health record adoption in office practices: a statewide survey.

OBJECTIVE: Despite emerging evidence that electronic health records (EHRs) can improve the efficiency and quality of medical care, most physicians in office practice in the United States do not currently use an EHR. We sought to measure the correlates of EHR adoption. DESIGN: Mailed survey to a stratified random sample of all medical practices in Massachusetts in 2005, with one physician per practice randomly selected for survey. MEASUREMENTS: EHR adoption rates. RESULTS: The response rate was 71% (1345/1884). Overall, while 45% of physicians were using an EHR, EHRs were present in only 23% of practices. In multivariate analysis, practice size was strongly correlated with EHR adoption; 52% of practices with 7 or more physicians had an EHR, as compared with 14% of solo practices (adjusted odds ratio, 3.66; 95% confidence interval, 2.28-5.87). Hospital-based practices (adjusted odds ratio, 2.44; 95% confidence interval, 1.53-3.91) and practices that teach medical students or residents (adjusted odds ratio, 2.30; 95% confidence interval, 1.60-3.31) were more likely to have an EHR. The most frequently cited barriers to adoption were start-up financial costs (84%), ongoing financial costs (82%), and loss of productivity (81%). CONCLUSIONS: While almost half of physicians in Massachusetts are using an EHR, fewer than one in four practices in Massachusetts have adopted EHRs. Adoption rates are lower in smaller practices, those not affiliated with hospitals, and those that do not teach medical students or residents. Interventions to expand EHR use must address both financial and non-financial barriers, especially among smaller practices.

Attitude to Computers↗
PubMed2006

Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care.

BACKGROUND: Despite the availability of expert guidelines and widespread diabetes quality improvement efforts, care of patients with diabetes remains suboptimal. Two key barriers to care that may be amenable to informatics-based interventions include (1) lack of patient engagement with therapeutic care plans and (2) lack of medication adjustment by physicians ("clinical inertia") during clinical encounters. METHODS: The authors describe the conceptual framework, design, implementation, and analysis plan for a diabetes patient web-portal linked directly to the electronic health record (EHR) of a large academic medical center via secure Internet access designed to overcome barriers to effective diabetes care. RESULTS: Partners HealthCare System (Boston, MA), a multi-hospital health care network comprising several thousand physicians caring for over 1 million individual patients, has developed a comprehensive patient web-portal called Patient Gateway that allows patients to interact directly with their EHR via secure Internet access. Using this portal, a specific diabetes interface was designed to maximize patient engagement by importing the patient's current clinical data in an educational format, providing patient-tailored decision support, and enabling the patient to author a "Diabetes Care Plan." The physician view of the patient's Diabetes Care Plan was designed to be concise and to fit into typical EHR clinical workflow. CONCLUSIONS: We successfully designed and implemented a Diabetes Patient portal that allows direct interaction with our system's EHR. We are assessing the impact of this advanced informatics tool for collaborative diabetes care in a clinic-randomized controlled trial among 14 primary care practices within our integrated health care system.

Ambulatory Care↗
PubMed2005

Improving electronic health record (EHR) accuracy and increasing compliance with health maintenance clinical guidelines through patient access and input.

BACKGROUND: Health maintenance is crucial for preventing morbidity and premature mortality, but many patients do not receive preventive services at recommended intervals. One reason for this is the lack of up-to-date information accurately reflecting patients' history. Electronic health records (EHRs) can be useful, but are often incomplete. Patient input has the potential to improve the accuracy of this information. In this study, we assessed the current state of EHR completeness for preventive services and the added value of patient reported information. METHODS: Participants were sent a survey, pre-populated with health maintenance procedure information from their EHRs. They were asked to review this information and indicate whether it was accurate or if they had a procedure done more recently. Of 1098 patients recruited from a primary care practice, 163 returned the survey. When a patient reported a more recent test than was noted in the EHR, researchers updated the EHR to reflect the additional information. Data were also gathered from the EHR 6 months after surveys were completed to analyze whether providing due test information encouraged patients to get tested and vaccinated. A review of medical records was performed on a control group to analyze differences in adherence to preventive guidelines between those that were notified of their overdue status and those who were not notified. RESULTS: The EHR was frequently incomplete when compared to patient report. In particular, many patients were misidentified as being overdue for health maintenance procedures when they had obtained them in other places. Showing patients their information resulted in little impact on overall adherence. However, with the cumulative effects of additional patient-reported procedures and procedures performed after the survey, intervention patients had higher documented adherence rates for every procedure than the control group. CONCLUSIONS: Health maintenance data in EHRs were often incomplete. Patients were often able to provide useful information, demonstrating the value of patient contributions in keeping records up-to-date.

Data Collection↗
PubMed2005

Impact of an Electronic Health Record on oncologists' clinic time.

The use of Electronic Health Records (EHRs) has been widely advocated to transform health-care delivery by improving quality, safety, and efficiency. Compared to a paper-based system, EHRs offer better access to clinical data and facilitate order entry and decision support. However, the benefits provided by EHRs do not eliminate the need to assess how such systems alter clinician time utilization. A major barrier to EHR use has been the concern that the EHR will take longer to use than paper-based systems. Few studies have addressed this issue in specialty clinic settings. We performed a time-motion study to evaluate how oncologists' time utilization differed before and after EHR implementation.

Humans↗
PubMed2004

Primary care physician time utilization before and after implementation of an electronic health record: a time-motion study.

Despite benefits associated with the use of electronic health records (EHRs), one major barrier to adoption is the concern that EHRs may take longer for physicians to use than paper-based systems. To address this issue, we performed a time-motion study in five primary care clinics. Twenty physicians were observed and specific activities were timed during a clinic session before and after EHR implementation. Surveys evaluated physicians' perceptions regarding the EHR. Post-implementation, the adjusted mean overall time spent per patient during clinic sessions decreased by 0.5 min (p=0.86; 95% confidence interval [-5.05, 6.04]) from a pre-intervention adjusted average of 27.55 min (SE=2.1) to a post-intervention adjusted average of 27.05 min (SE=1.6). A majority of survey respondents believed EHR use results in quality improvement, yet only 29% reported that EHR documentation takes the same amount of time or less compared to the paper-based system. While the EHR did not require more time for physicians during a clinic session, further studies should assess the EHR's potential impact on non-clinic time.

Attitude of Health Personnel↗
PubMed2004

The Internet as a vehicle to communicate health information during a public health emergency: a survey analysis involving the anthrax scare of 2001.

BACKGROUND: The recent public health risks arising from bioterrorist threats and outbreaks of infectious diseases like SARS (Severe Acute Respiratory Syndrome) highlight the challenges of effectively communicating accurate health information to an alarmed public. OBJECTIVE: To evaluate use of the Internet in accessing information related to the anthrax scare in the United States in late 2001, and to strategize about the most effective use of this technology as a communication vehicle during times of public health crises. METHODS: A paper-based survey to assess how individuals obtained health information relating to bioterrorism and anthrax during late 2001. We surveyed 500 randomly selected patients from two ambulatory primary care clinics affiliated with the Brigham and Women's Hospital in Boston, Massachusetts. RESULTS: The response rate was 42%. While traditional media provided the primary source of information on anthrax and bioterrorism, 21% (95% CI, 15%-27%) of respondents reported searching the Internet for this information during late 2001. Respondents reported trusting information from physicians the most, and information from health websites slightly more than information from any traditional media source. Over half of those searching the Internet reported changing their behavior as a result of information found online. CONCLUSIONS: Many people already look to the Internet for information during a public health crisis, and information found online can positively influence behavioral responses to such crises. However, the potential of the Internet to convey accurate health information and advice has not yet been realized. In order to enhance the effectiveness of public-health communication, physician practices could use this technology to pro-actively e-mail their patients validated information. Still, unless Internet access becomes more broadly available, its benefits will not accrue to disadvantaged populations.

Ambulatory Care Facilities↗
PubMed2004

Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients.

BACKGROUND: Patient demand for email contact with physician practices is high. If physicians met this demand, improvements in communication, quality of care and patient satisfaction could result. However, physicians have typically been hesitant to communicate electronically with patients, largely due to concerns relating to workload, security and lack of compensation. GOAL: To assess physician attitudes towards electronic communication with patients six months after the implementation of an application called Patient Gateway. Patient Gateway allows patients to access an extract of their medical record and facilitates online communication with medical practices. METHODS: A paper-based survey was administered to the 43 primary care physicians in one integrated delivery system, with a 56% (24/43) response rate. RESULTS: Overall, physicians felt that Patient Gateway's impact on their practices was positive, especially in the areas of refill and referral request management and appointment scheduling. However, physicians are still hesitant to increase general electronic communication with patients; none opted to use Patient Gateway's general messaging function with patients, and those who had previously used outside systems to exchange emails with some patients continued to communicate with only a small proportion of their patient panel in this way. However, 38% of physicians already communicate with their own physicians via email, and another 19% would like to do so. CONCLUSIONS: Physicians' fears about being overwhelmed with messages were not realised. While physicians were generally enthusiastic about the application, none used it directly to communicate with patients. Over three-quarters of respondents indicated that they would be more enthusiastic about electronic communication with patients if this time were compensated.

Attitude of Health Personnel↗
PubMed2003

Opportunities to enhance patient and physician e-mail contact.

The purpose of our study was to evaluate how e-mail is currently used between physicians and patients in an integrated delivery system, and to identify developments that might promote increased use of this form of communication. A paper-based survey questionnaire was administered to 94 primary care physicians. We evaluated the role e-mail currently plays in a physician's typical work day, physician views on the impact of e-mail on phone use and the barriers to increasing the use of e-mail with patients. 76% of physicians surveyed responded. All respondents currently use e-mail. Close to 75% of physicians use e-mail with their patients, but the vast majority do so with only 1-5% of those patients. 50% of physicians believe that up to 25% of their patients would send e-mail to them if given the option, with an additional 37% believing that between 25% and 50% of patients would value this option. The main reported barriers to physician-patient e-mail related to workload, security and payment. Our survey findings indicate that with adequate pre-screening, triage, and reimbursement mechanisms physicians would be open to substantially increasing e-mail communication with patients.

Adolescent↗
PubMed2003

Physicians' perceptions toward electronic communication with patients.

Despite the widespread use of email, electronic communication between physicians and patients is not part of the standard physician-patient relationship in the United States. Increased use of email may improve physician-patient communication, which is associated with improved patient satisfaction and health status. Evaluating email communication in this context is vital to minimizing potential risks and maximizing benefit to physicians and patients. We evaluated email use between physicians and patients, and physicians perceptions of the value and issues surrounding this form of communication in order to identify issues that would facilitate and improve electronic communication.

Attitude of Health Personnel↗